603 The architecture of adversity: structural determinants of refugee health across trauma, exclusion, and resilience

Abstract OP 11: Determinants of Health Disease and Interventions 3, B207 (FCSH), September 3, 2025, 17:00 - 18:00 Aim This review synthesizes current understanding of how pre-migration trauma, post-migration socioeconomic exclusion, and community cohesion collectively shape health outcomes among resettled refugees, with particular focus on structural determinants across global resettlement contexts. Methods We examined literature from PubMed, PsycINFO, and Scopus (2010–2025) through targeted searches combining key search terms: refugee, health, social determinants, barriers, resilience, and equity. Results Three robust patterns emerge consistently across the literature. First, while pre-migration trauma significantly influences mental health, post-migration socioeconomic exclusion—particularly housing instability and employment barriers—demonstrates stronger associations with both physical and mental health burdens. These material deprivations often mediate trauma’s long-term impacts through chronic stress pathways. Second, systemic discrimination within healthcare systems compounds disparities through intersecting obstacles including cultural insensitivity in clinical encounters and bureaucratic complexities that create pronounced access barriers for undocumented populations. Third, community cohesion initiatives effectively counteract these challenges; trauma-informed peer networks and cultural brokering programs substantially mitigate adverse outcomes while restoring agency and improving healthcare engagement where institutional systems falter. Conclusions Refugee health outcomes depend fundamentally on post-migration structural conditions. Effective responses require integrated approaches: healthcare reforms must address discriminatory practices through cultural competency mandates and simplified administrative processes, while material security policies should ensure stable housing through targeted vouchers and livelihood access through accelerated work permits. Strategic investment in community-led initiatives remains critical, particularly sustainable funding for peer support networks and cultural mediation programs. Future research should prioritize longitudinal examinations of how these interventions impact diverse vulnerability profiles across resettlement contexts, while centering refugee voices in solution design to transform structural determinants of health inequity.